Mobile Apps in Clinical Settings

American Telemedicine Association29 April 2012

Robert Ciulla, Ph.D.

National Center for Telehealth & Technology

Joint Base Lewis-McChord, Tacoma, WA

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Interview with the Father of Cell Phones

• 2011 ATA Opening Plenary: NY Times’ David Pogue interviews Dr. Martin Cooper

Life-Altering Mobility

• Wharton School biggest “life changers” of past 30 years: – Internet, PC/laptop, mobile phones, email, DNA

sequencing

• From 2008-2010 mHealth consistently outpaced forecast growth and revenue– mHealth apps will continue on a steep growth curve

as increasingly mobile technologies disrupt the market

– Mobile apps are the single-biggest digital channel since the ‘90s and the Web

1973… 2012

• Mobile broadband subscriptions: 200 million in 2008 to 1.2 billion in 2011; projected to reach 3.8 billion by 2015

• 2011: U.S. mobile health market at $718m • March 2012: 46% of American adults own

smartphones – up from 35% in May 2011 • By 2013, more users will connect to the Internet

via mobile devices than PCs. • By 2013, 500m people will use mHealth apps

Health Care Survey

• 2011-2012 survey of U.S. & int’l health IT– 85% support use of personal devices by

physicians and hospital staff – 83% report their hospital supports clinician

use of iPads in next 24 months– 60% reported their hospital supports

electronic medical record mobile apps– 50% of hospitals to upgrade mobile health

capabilities

What is Mobile Health (mHealth)?

• “The practice of medicine and public health, supported by mobile devices.”

• “The delivery of healthcare services via mobile communication devices.”

• “Umbrella term for wireless devices that are used in healthcare. It includes mobile monitors worn by patients as well as smartphones that physicians and nurses use to obtain and disseminate information.”

If We Build It, Will They Use It?

• Hong Kong physicians – Pragmatic, less concerned with ease-of-use

and more interested in usefulness– Expressed concerns about the compatibility of

the technology with their practices

• Australian/Indian cross-national study– Tech acceptance is more likely when it

supports clinical management– Barriers to use must be minimized

Mobile Issues

• Physicians using mobile devices for patient care aren't connected to practice or hospital IT systems

• Physician concerns about privacy and security when adopting mobile health tools

• Hospital networks need more bandwidth to support rapid exchange of data.

Getting Authentic(ated)

• Authentication systems:–Something you know (password)–Something you have (ID badge,

keycard)–Something you are (biometrics)

More Mobile Issues: Is It A Medical Device?

• Food and Drug Administration (FDA)

• Health Insurance Portability and Accountability Act (HIPAA)/ file-sharing

If We Build It, Will They Know How to Use It

• Technology: what’s your comfort level?

• Data are as good as human input allows

• Applications: bugs, crashes (what if: lab results appended to wrong record)

• Using both paper and electronic systems

Current Uses in Behavioral Health

• Various disorders (developmental, cognitive, substances, mood, eating, sleep)

• Informational, assessment, track/graph, interactive tools, self-monitoring prompts

• Mobile apps’ many other capabilities:– Calendars, file-sharing, therapist audio-recordings, date-stamp

homework assignments– Real-time audio/ video coaches (telehealth)– Global positioning system (GPS)– Wearable sensors (biofeedback)

Luxton et al. – mHealth for Mental Health: Integrating Smartphone Technology inBehavioral Healthcare. Professional Psychology: Research and Practice. 2011, Vol.42, No.6, 505-512.

If We Build It, Will They Know How to Use It in a Clinical Setting

• Online workbooks

• Telehealth

• Mobile applications

Online Workbooks

Telehealth

Mobile Apps

Technology “CPGs”

• A “how-to” instructional manual• What is a mobile application?• Clinical practice benefits

– Availability, access to critical resources, communication, evidence-based content, assessment, tracking, remote monitoring, flexible encounters/ bridge

• The “bipersonal field”/ asynchrony

• Charting mobile communications• Storage of transmitted data• Practical exercises

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T2 Mood Tracker

Self-monitor, track and reference emotional experiences over a period of days, weeks and months.

Features: - Self-rating on pre-populated categories- Full note adding - Graphed results- Fully customizable categories - User-set reminders for self-rating- Send results to providers (upcoming)

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LifeArmor

Currently in beta version (soft release)

A multi-topic application derived from AfterDeployment.org to provide the user with knowledge and tools to cope with the many challenges faced by today’s service members.

Features: - Multi-topic resource guide- Self-assessments of topic symptoms- Ease to manage, customizable views and favorites- Manage symptoms with coping tools- Video resources on topics

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mTBI Pocket Guide

Clinical Practice Guidelines for treatment of mTBI

Features: - Quick results with coding guidance- Symptom management lists- Summary of clinical recommendations- Patient education resources- Clinical tools and resources

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mTBI Co-occurring Conditions Toolkit

Co-occurring Conditions Toolkit: Mild Traumatic Brain Injury and Psychological Health

Features:– Guidance to primary care providers

on the assessment and management of patients

– Synthesizes information from the following VA/DoD CPGS: mTBI, PTSD, depression, chronic opioid therapy and substance use disorder

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Provider Resilience

Deploying Summer 2012Currently field testing downrange

Self-care tool for health care providers who work with service members and who may need support in coping with burnout or compassion fatigue

Features: - Quick dashboard view- Graphing to track resilience progress- Tools to assist increasing resilience- Inspirational value cards- User-set reminders to update assessments

Provider Education

Service Delivery in the 21st Century

• The (very) educated consumer.

• Social networks

• Participatory Medicine / Patient-Centered Medical Home

• Consumer-centric

• Security / privacy

• Informatics (the “measured life”)

• The virtual “clinical setting” 24

Next Generation

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Mobile Trivia

• 70% of people sleep with their cell phone;

90% of “digital natives” (under 30)

• There are more mobile phones in the world than toothbrushes.

Contact Information

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Robert Ciulla, Ph.D.Chief, Population & Prevention Programs |P3|National Center for Telehealth and Technology |T2|Joint Base Lewis-McChord, Tacoma, WArobert.ciulla@us.army.mil

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